Ultrasound-guided carotid angioplasty and stenting in a patient with iodinated contrast allergy:A case report

BACKGROUND Ischemic stroke is an entity with high incidence,morbidity,and mortality rates.Carotid artery stenosis is an important and independent risk factor for ischemic stroke.The three current approaches for treating carotid artery stenosis are drug treatment,carotid endarterectomy(CEA),carotid angioplasty and stenting(CAS).The approach is chosen based on the degree of stenosis.CEA or CAS could have been chosen for the current patient,who had severe carotid stenosis and an iodinated contrast allergy.After thoroughly communicating with the patient,the patient chose CAS for treatment.Therefore,we performed ultrasound-guided CAS to avoid the use of iodinated contrast.CASE SUMMARY The main symptoms of the patient were numbness and weakness of the left limb.Computed tomography angiography of the head and neck at another hospital indicated multiple sites of stenosis in the arteries of the head and neck.The patient requested CAS for treatment but was allergic to iodinated contrast media.Thus,routine digital subtraction angiography(DSA)with iodinated contrast could not be used for the procedure.The diagnosis of this patient was as follows:(1)Right parietal lobe cerebral infarction;(2)multiple sites of stenosis in the arteries of the head and neck(severe stenosis of the right internal carotid artery,severe stenosis of the right subclavian artery);(3)right subclavian steal syndrome;and(4)hypertension(stage 3,high risk).The interventions included routine treatment for cerebral infarction,oral administration of clopidogrel(75 mg qd)and aspirin(100 mg qd),ultrasound-guided CAS,and postoperative follow-up.Postoperative color Doppler ultrasound and cerebrovascular magnetic resonance angiography of the carotid artery showed good vascular recovery,and the postoperative follow-up indicated a good prognosis.CONCLUSION This case study suggests that ultrasound-guided endovascular treatment is a potential option for patients with contraindications to the iodinated contrast agents used in DSA-guided surgery,although excellent surgical operating skills are needed.

Two-Stent Strategy for Bifurcation Lesions in Percutaneous Transluminal Coronary Angioplasty: Real-World Evidence

Background: Bifurcation lesions pose a high risk for adverse events after percutaneous coronary intervention (PCI). Evidence supporting the benefits of the two-stent strategy (2SS) for treating coronary bifurcation lesions in India is limited. This study aimed to evaluate the clinical outcomes of various 2SSs for percutaneous transluminal coronary angioplasty for bifurcation lesions in India. Materials and Methods: This retrospective, observational, multicentric, real-world study included 64 patients over 8 years. Data on demographics, medical history, PCI procedures, and outcomes were recorded. Descriptive statistics were computed using the SPSS software. Results: Patients (n = 64) had an average age of 65.3 ± 11.1 years, with 78.1% males. Acute coronary syndrome was reported in 18.8%, chronic stable angina in 40.6%, and unstable angina in 34.4% of participants. Two-vessel disease was observed in 98.4% of patients, and 99.4% had true bifurcation lesions. The commonly involved vessels were the left anterior descending artery (50%), left circumflex coronary artery (34.4%), and first diagonal artery (43.8%). Mean percent diameter stenosis was 87.2% ± 10.1%. The mean number of stents used was 2.00 ± 0.34. The 2SS techniques included the T and small protrusion (TAP) (39.1%), double kissing (DK) crush (18.8%), and the culotte techniques (14.1%). Procedural and angiographic success rate was 92.18%. Major adverse cardiovascular events at 1-year follow-up occurred in 7.8% of cases. Conclusion: The 2SS for bifurcation lesions showed favorable in-hospital and follow-up outcomes. Findings can serve as a resource for bifurcation angioplasty in India. Larger real-world studies with robust methodology are needed to validate these results.

Safety and efficacy of balloon angioplasty compared to stent-basedstrategies with pulmonary vein stenosis:A systematic review and meta-analysis

BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS.We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories.In adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included.The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications.The metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical heterogeneity.RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria.The age range of patients was 6 months to 70 years and 67%were males.The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group.Compared to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group.There were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.

Hepatic artery stenosis angioplasty and implantation of Wingspan neurovascular stent: A case report and discussion of stenting in tortuous vessels

BACKGROUND Hepatic artery stenosis is a complication of orthotopic liver transplant occurring in 3.1%-7.4%of patients that can result in graft failure and need for retransplantation.Endovascular therapy with angioplasty and stenting has been used with a high degree of technical success and good clinical outcomes,but tortuous hepatic arteries present a unique challenge for intervention.Suitable stents for this application should be maneuverable and conformable while also exerting adequate radial force to maintain a patent lumen.CASE SUMMARY Herein we report our experience with a neurovascular Wingspan stent system in a challenging case of recurrent hepatic artery stenosis and discuss the literature of stenting in tortuous transplant hepatic arteries.CONCLUSION Wingspan neurovascular stent is self-expanding,has good conformability,and adequate radial resistance and as such it could be added to the armamentarium of interventionalists in the setting of a tortuous and stenotic transplant hepatic artery.

Clinical study about the effect of Simiao Yong'an Decoction on preventing in-stent restenosis and regulating inflammation and oxidative stress after lower extremity stent angioplasty stenting

Objective:To study the effect of Simiao Yong'an Decoction on the prevention of in-stent restenosis and the regulation of inflammation and oxidative stress after lower extremity stent angioplasty.Methods:A prospective study was conducted on 60 ASO patients who underwent lower extremity stent angioplasty in our hospital between January 2014 and January 2018.The patients were randomly divided into observation group receiving postoperative Simiao Yong'an Decoction combined with antiplatelet drug treatment and control group receiving postoperative antiplatelet drug treatment.The conditions of in-stent restenosis were followed up,and the indicators of coagulation,inflammation and oxidative stress were detected.Results:The incidence of in-stent restenosis in observation group 1 year after operation was significantly lower than that in control group;6 months and 12 months after operation,the ankle brachial index(ABI)levels,minimal lumen diameter(MLD)levels at the stent and superoxide dismutase(SOD)contents of observation group were significantly higher than those of control group,whereas D-dimer(D-D)and fibrinogen degradation product(FDP)levels as well as P-selectin,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),malondialdehyde(MDA)and inducible nitric oxide synthase(iNOS)contents were significantly lower than those of control group.Conclusions:Simiao Yong'an Decoction can prevent the in-stent restenosis and inhibit the inflammation and oxidative stress after lower extremity stent angioplasty.

Response of blood pressure after percutaneous transluminal renal artery angioplasty and stenting

AIM: To evaluate the short and intermediate term out-come of percutaneous transluminal renal artery angioplasty (PTRA) and stenting particularly on blood pressure (BP) control and renal function and to evaluate predictors of poor BP response after successful PTRA and stenting. METHODS: We conducted a prospective analysis of all patients who underwent PTRA and stenting in our institute between August 2010 to September 2012. A total number of 86 patients were underwent PTRA and renal stenting. Selective angiography was done to confirm at least 70% angiographic stenosis. The predilatation done except few cases with critical stenosis, direct stenting was done in the rest of cases. All patients received aspirin 325 mg orally, and clopidogrel 300 mg orally within 24 h before the procedure. Heparin was used as the procedural anticoagulant agent. Optimal results with TIMI-Ⅲ flow obtained in all cases. Following stent placement, aspirin 150 mg orally once daily was continued for a minimum of 12 mo and clopidogrel 75 mg orally once daily for at least 4 wk. The clinical, radiological, electrocardiography, echocardiography and treatment data of all patients were recorded. The BP measurement, serum creatinine and glomerular filtration rate (GFR) were recorded before the procedure and 1 and 6 mo after PTRA. RESULTS: A total of 86 patients were included in the study. The mean age of study population was 55.87±11.85 years old and 67 (77.9%) of patients were male. There was a significant reduction in both systolic and diastolic BP at 1 mo after the procedure: 170.15±20.10 mmHg vs 146.60±17.32 mmHg and 98.38±10.55 mmHg vs 89.88±9.22 mmHg respectively (P=0.0000). The reduction in BP was constant throughout the follow-up period and was evident 6 mo after the procedure: 144.23±18.19 and 88.26±9.79 mmHg respectively (P=0.0000). However, no improvement in renal function was observed at any time during the follow-up period. After multivariate analysis, we found male sex, low GFR (<60 mL/min) and higher baseline mean BP as a poor predictors of successful outcome on BP response after PTRA and stenting. CONCLUSION: The PTRA and stenting can be considered as an effective therapeutic intervention for improving BP control with minimal effect on renal function. The male sex, higher baseline BP and low GFR are associated with poor BP response after successful PTRA and stenting.

Efficacy of Solitaire AB stent-release angioplasty in acute middle cerebral artery atherosclerosis obliterative cerebral infarction

BACKGROUND In both national and international studies,the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good,and the disability rate was significantly reduced.However,there are currently only a few reports on the differences in endovascular treatment for different etiological classifications,especially in the anterior cranial circulation,aorta atherosclerotic stenosis,and acute thrombosis.AIM To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.METHODS Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019.The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis[modified thrombolysis in cerebral infarction(mTICI)]at the 2b/3 level or above,the stent was then unfolded and released.RESULTS All 25 patients underwent successful surgery,with an average recanalization time of 23 min.One patient died of cerebral hemorrhage and cerebral herniation after the operation.The National Institutes of Health Stroke Scale(NIHSS)scores immediately after surgery(7.5±5.6),at 24 h(5.5±5.6)and at 1 wk(3.6±6.7)compared with the preoperative NIHSS score(15.9±4.4),were significantly different(P<0.01).One case of restenosis was observed 3 mo after surgery(the stenosis rate was 50%without clinical symptoms),the modified Rankin scale scores were 0 points in 14 cases(56%),1 point in 4 cases(16%),2 points in 2 cases(8%),3 points in 3 cases(12%),4 points in 1 case(4%),and 6 points in 1 case(4%).CONCLUSION In acute middle cerebral artery atherosclerosis obliterative cerebral infarction,when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher,stent release may be a safe and effective treatment method;however,long-term observation and a larger sample size are required to verify these findings.

Matrix metalloproteinase 9 level as an indicator for restenosis following cervical and intracranial angioplasty and stenting

Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that resteno-sis occurred in 30% （3/10） of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% （2/17） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% （1/23） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically signiifcant （P 〉 0.05）. Experimental ifndings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervi-cal and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.

Angioplasty with Stent for Symptomatic Intracranial Stenosis Trial I (ASSIT-Ⅰ) Study

Background and Purpose Annual stroke rates might be as high as 10% to 24% in patients with symptomatic intracranial stenosis on best medical therapy. Angioplasty with stent for symptomatic intracranial stenosis trial Ⅰ (ASSIST-Ⅰ) was a prospective and nonrandomized feasibility and safety study to evaluate the APOLLO Stent System for treatment of symptomatic intracranial artery stenosis, and prepare for ASSIST Ⅱ-a prospective, multicenter,and randomized controlled-study. The APOLLO stent delivery system (MicroPort Medical [Shanghai] Limited Co.), specifically designed for intracranial artery stenosis, consists of a stent and a balloon and a rapid-exchange delivery catheter. The stent is made of 316L stainless steel, with diameters of 2.0 to 4.0 mm and length of 8 mm or 13 mm. Only two links connect the rings of 1 mm in length, rendering the stent a good flexibility enough to navigate tortuous intracranial vessels. The nominated pressure of the stent is designed at 6 atm to reduce the risk of occlusion to side branches and perforators and rupture and dissection of target vessel. The crimping technique is applied in this system, insuring a compact ability of stent so wonderful that the struts of stent do not lift when the stent negotiates a turn, which lessen the likelihood of vessel wall injury and stent migrating. Materials and methods Thirty-four patients with 35 symptomatic intracranial stenoses of ≥50%, which resulted in transient ischemic attacks (TIAs [23 lesions /22 patients]) and minor stroke (7 lesions/7 patents), and both TIAs and stroke (5 lesions/ 5 patients), and with 1 asymptomatic severe stenosis, were enrolled in ASSIST-Ⅰ from December 10, 2003 to August 12, 2004. Their age was 54.3 years±SD of 9.49, three patients were male, and all had ≥1 risk factors of atherosclerosis. Patients received the evaluation of National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS )and Barthel idex (BI) before and one-, three-, six-, and 12-month after the procedure. Results Stent success, defined as stent-assisted angioplasty successfully, resulting in ≤20% residual stenosis, was obtained in 35 lesions ( 97.2%, 35/36) and 33 patients ( 97.1%, 33/34). The stenosis rate of pre- and post -procedure was 80.5%± SD of 12.65 and 7.4%±SD 15.74, respectively. The Procedure-related complications were 8.3% for lesion (3/36) and 8.8% for patient (3/34), included 1 acute thrombosis, which obtained complete patency by means of intrathrombus thombolysis at once without sequelae, and 2 ischemic perforator strokes (1 irreversible stroke and 1 reversible). The disable stroke, defined as one that led to mRS score of ≥2, 30 days after the stroke, occurred in one patient ( 2.9%, 1/34; mRS of 2). Procedure success, defined as stent success without disable stroke or death at discharge by means of the endovascular therapy, was achieved in 33 lesions ( 91.7%, 33/36) and in 31 patients ( 91.2%, 31/34). Treatment success, defined as stent success without disable stroke and death at the 30th day, by means of the endovascular and medical therapy, was obtained in 34 lesions ( 94.4%, 34/36) and 32 patients ( 94.1%, 32/34). Clinical Follow-up, median 170 days (ranged from 30 days to 273 days; ≥1 month, n=34; ≥3 months, n=23; ≥6 months, n=13), was performed in 34 patients. There were no ischemic neurological events and death occurred. Cumulated disable stroke occurred in 1 patient ( 2.9%, 1/34). NIHSS was 1.09±SD of 1.694 and 0.47±SD of 1.051, before procedure and at the 30th day (n=34), respectively, and 0.57±SD of 0.992 at 3 months (n=23), 0.15±SD of 0.376 at 6 months (n=13), respectively; mRS was 0.65±SD of 0.812 and 0.47±SD of 0.563, before procedure and at 30 days, respectively, and 0.61±SD of 0.583 at 3 months, 0.38±SD of 0.506 at 6 months, respectively; and BI was 97.54±SD of 5.918 and 99.26±SD of 2.179, before procedure and at 30 days, respectively, and 99.35±SD of 2.288 at 3 months, 100.00±SD

Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

Carotid artery angioplasty and stenting in elderly patients： the advantage of being an interventional cardiologist

客观颈动脉 angioplasty 和 stenting (CAS ) 被建议了是在有高风险的病人的选择的过程心血管的侧面。不幸地，如此的病人与几 comorbidities 经常是年老的，例如复杂化 CAS 表演的冠的动脉疾病，外部动脉疾病和敌对解剖的高流行。我们寻求了在老病人评估 CAS 的结果，构画出遇到的挑战和最终的建议全球心血管的管理。我们回顾地在数据库找了病人的方法 > 被指的 65 岁的孩子心血管的诊断和 Endoluminal 干预， Rovigo 医院将军，在为 CAS 的 24 月的经期(12 月 2007-November 日 2009 ) 上。冠的 angiography 并且外部屏蔽在所有病人被执行。所有最终的挑战和相关答案被分析。完全结果， 160 个病人被注册。在哪个之中， 50 个病人(31.2% ，意味着年龄 80 搠癥？

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Long Term Clinical and Angiographic Outcome Following Percutaneous Transluminal Angioplasty and Stent Placement for Iliac and Femoral Artery Stenosis

Objective This study reportsthe initial and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac and femoral arteries. Methods and Results From December 1994 to March 1997, we performed iliac and femoral artery angioplasty and primary intravascular stent placement in 37 vessel of 33 patients (19 men and 14 women; mean age, 70. 5 years). A total of 43 self - expanding Wallstents (Boston, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Clinical follow - up was available for all patients at a mean of 26±14months. All patient clinical is-chemic category (claudication or rest pain) was improved. Angiographic follow - up was completed for 17 of 23 patients at a mean follow-up of 10±5 months, The iliac artery restenosis rate was 0(0/8). The femoral artery restenosis rate was 33 % (3/9), All 3 patients underwent repeat balloon angioplasty successfully. Conclusion The iliac and femoral arteries can be performed and reasonable early and late patency rates.

Successful opening in-stent chronic total occlusion lesion of coronary artery by excimer laser coronary angioplasty

In percutaneous coronary intervention (PCI), chronic total occlusion (CTO) coronary artery disease still remains difficult to treat. One of the reasons for the failure is the hard of the CTO lesions that balloon is difficult to pass through or expand. Previous methods to deal with CTO lesions that cannot be passed by balloon, include selecting reinforced catheter (such as 5 in 6 guiding catheter, Guidzilla catheter, or Tornus microcatheter), guidewire extrusion or rotary grinding technology. In recent years, excimer laser coronary angioplasty (ELCA) has been gradually applied to CTO lesions. Using inert halide as the laser medium, ELCA emits a 308 nm high-intensity unidirectional light wave with absorption depth of only 50 μmL, resulting in less thermal effect and less damage to non-target lesions. In this paper, we will describe a successful PCI case of an in-stent CTO lesion using ELCA with long term coronary angiography follow-up.

Optical coherence tomography-guided excimer laser coronary angioplasty in overlapping stents with severe under-expansion and underlying calcification

Excimer laser coronary angioplasty(ELCA)modifies atherosclerotic plaques through its photochemical,photothermal and photodynamic characteristics,while making up for the limitations of intimal disassembly and restenosis of balloon angioplasty without causing significant damage.The American Food and Drug Administration approved of the first clinical application of ELCA in 1992.Since then,ELCA has been used as an adjunct therapy in the treatment of various subsets of coronary artery lesions.ELCA considered to be a relatively safe and effective technique for coronary lesions when routine angioplasty is technically insufficient.

Prolonged high-pressure balloon angioplasty of femoropopliteal lesions：Impact on stent implantation rate and mid-term outcome

ObjectivesTo 在 stent 培植率和回顾地注册的 femoropopliteal lesions.MethodsWe 的延长高压力 angioplasty 的中间的结果上估计影响从 2011 年 1 月的 620 个连续病人到 2011 年 12 月(75.6 &#x000b1；12.3 年， 355 男性， 76.5% 在卢班 5-6 ) ，为批评手足局部缺血参考了并且提交了到 femoropopliteal 损害的延长高压的 angioplasty。延长高压的 angioplasty 的定义为至少 120 s 包括膨胀到至少 18 atm。程序的数据，和临床、仪器的后续被分析估计比较喜欢的培植率和中间的 outcomes.ResultsThe 接近的 stent 是 ipsilateral 在 433/620 病人(69.7%) 和在 164/620 (26.4%) 的 contralateral 转线路的大腿骨的 antegrade 并且腿弯部后退 +在 23/620 (3.7%)的大腿骨的 antegrade 。技术在 193/620 病人(31.2%) 在 427/620 病人(68.8%) 和 endoluminal angioplasty 包括了 subintimal angioplasty。延长高压力汽球 angioplasty 过程在 86.2% 是成功的(次要的 intra 程序的复杂并发症率 15.7 %) ， stent 培植在 74 个病人(11.9%) 被执行，与脚关节臂的索引的重要改进(0.29 &#x000b1；0.6 对 0.88 &#x000b1；0.3， P &#x0003c；00.1 ) 并且卢班(5.3 &#x000b1；0.8 对 0.7 &#x000b1；1.9， P &#x0003c；0.01 ) ， 86.7% 的主要明显率， Doppler 超声和在 18.1 &#x000b1 的吝啬的后续的 14.8% 的目标损害 revascularization 上的 18.6 % 的狭窄；6.4 个月(范围 1-24 月) 。第二等的明显率高是 87.7%.ConclusionsProlonged femoropopliteal 损害的压力 angioplasty 看起来安全、有效允许可接受的明显和狭窄在期中考试上评价。

Cutting-balloon angioplasty before drug-eluting stent implantation for the treatment of severely calcified coronary lesions

BackgroundSeverely 钙化的冠的损害对汽球 angioplasty 糟糕作出回应，导致不完全、不均匀的 stent 扩大。因此，在 drug-eluting stent (DES ) 以前的足够的匾修正培植是为钙化的损害治疗的钥匙。这研究是评估为严重地钙化的冠的 lesions.MethodsNinety 切汽球 angioplasty 的安全和功效 -- 有严重地钙化的损害的二个连续病人(定义为钙弧 ≥；180 °；钙长度比率 ≥；0.5 ) 在 DES 培植随机基于汽球类型被划分成二个组以前，与汽球膨胀对待：在常规汽球 angioplasty (BA ) 的 45 个病人组织，在切的汽球 angioplasty (CB ) 的 47 个病人组织。在 BA 组的七个盒子令人满意地没完成膨胀并且被变成 CB 组。 Intravascular 超声( IVUS )在汽球膨胀前并且在 stent 培植以后被执行获得质、量的损害特征并且评估 stent ，包括最小的腔代表性的区域( CSA )，钙化的弧和长度，最小的 stent CSA ， stent 并置， stent 对称， stent 扩大，容器解剖，并且分叉容器监狱。在里面医院， 1 月、 6 月的主要不利心脏的事件(向) 是 reported.ResultsThere 不是在在二个组之间的临床的特征的统计差别，包括钙弧(222.2 °；±；22.2 °；对 235.0 °；±；22.1 °；， P = 0.570 ) ，钙长度比率(0.67 ±；0.06 对 0.77 ±；0.05， P = 0.130 ) ，并且在一种总线标准前的最小的腔 CSA (2.59 ±；0.08 公里 2 对 2.52 ±；0.08 公里 2, P = 0.550 ) 。在 stent 培植以后，最后的最小的 stent CSA (6.26 ±；0.40 公里 2 对 5.03 ±；0.33 公里 2 ；P = 0.031 ) 并且尖锐的腔获得(3.74 ±；0.38 公里 2 对 2.44 ±；0.29 公里 2, P = 0.015 ) 比 BA 组的在 CB 组是显著地更大的。没有统计上在在二个组之间的 stent 扩大， stent 对称，不完全的 stent 并置，容器解剖和分支容器监狱的差别。在在严重地钙化的损害的 DES 培植看起来是包括显著地更大的最后的 stent CSA 和更大的尖锐的腔获得的更多的功效以前， 30 天、 6 月的向率也不是 different.ConclusionsCutting 汽球 angioplasty，没有增加在操作和 MACE 率在期间的复杂并发症 6 月。

Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery.It is believed that lesser stent material within the bladder mitigates stent-related symptoms.This study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention.Methods:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were analysed.Parameters compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal.Results:Both groups had similar median age,distribution in male to female ratio,and stone size.The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at voiding.Both groups had similar ease in insertion with no hospital readmissions.Conclusion:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues.It showed a good safety profile with easy deployment and removal.It promises a new standard in stenting.

Application of GlycoProtein lib／Ⅲa antagonist（Integrilin） in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese

Objective: to report the application of GPⅡb/Ⅲa antagonist (Integrilin) in peri-opercuta-neous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty-one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then main-tained at 2μg/kg·min for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 aeconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the preand post-procedure value of PT and platelet count. KPTT was significantly higher than pre-procedure value at 2 hours after the procedure . No recurrence of angina pectoris was observed in the first nine patients within one year follow-up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPⅡb/Ⅲa receptor antagonist (Integrilin)in peri-parcutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.

The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy.Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success.Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001;women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001).Conclusion: The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.